AccountId: 011433970860
ContactId: 60eddcf5-6429-47e5-9eb8-d65f1256611b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 160740 ms
Total Talk Time (AGENT): 62572 ms
Total Talk Time (CUSTOMER): 87576 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/60eddcf5-6429-47e5-9eb8-d65f1256611b_20250317T13:18_UTC.wav
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[AGENT][NEUTRAL] This is how may I help you?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Hello, good morning. This is [PII] from customer service.
[AGENT][NEUTRAL] This [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I have an insured on the line, Ms. [PII], uh, with policy number 2549423.
[AGENT][POSITIVE] Yes, how can I help?
[CUSTOMER][NEUTRAL] Um, she has been fully verified and everything. She, she received a letter about um that all her benefits have been exhausted and she has, she wants to verify if this is correct or not, and she has not um used this policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, this is for her. She's, she's saying that she hasn't used it.
[CUSTOMER][NEGATIVE] Yes, she hasn't used it for her.
[AGENT][POSITIVE] Oh, OK. Um, absolutely, I can certainly look that up. Um, yes, thank you. Uh, I can, I can help her.
[CUSTOMER][NEUTRAL] All right. And her callback number is the one in the system. It's the same one, the one ending in [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Good morning. My name is [PII]. I'm in the claims department, [PII]. I'm just looking up your policy right now. Thank you for staying on the line with me. Um, now, if I understand, uh, you're saying that you didn't use your policy, uh, for the current year, is that correct, ma'am?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] Oh, no, I just wanted to know, I, since I've never gone to the hospital in the 5 years that I've had American public life, I, I didn't know there was like a cap, and I guess I went to the hospital in November and they billed me $19,883 which is absurd, but it's OK, um, and then my, my regular insurance covered most of it, and I guess you guys covered the rest, um, but I didn't know there was a cap. What is the cap because I guess I'm being billed $1000 too.
[AGENT][NEUTRAL] Oh yes, of course. Um, so what's, uh, for outpatient services, uh, we will pick up the deductible, co-payment or co-insurance up to $6000. Um, now what we did was, yeah, we, we received something from Baptist Hospital and what they were charging you was $7,0014 and, and yeah, we paid the remainder of that. The $6000.
[CUSTOMER][NEUTRAL] That's why.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got it, but it's up to 6000, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, that's, that's why. No, I just wanted to confirm with you guys first before I call [PII] to do like a payment plan or whatever, OK.
[AGENT][NEUTRAL] Oh, of course. Is there anything else at all I may help with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright then
[CUSTOMER][NEUTRAL] Um, no, that was it. I just wanted to confirm that that was the, you know, that was the cut off.
[AGENT][POSITIVE] Uh-huh, that would, that's it, the $6000. OK, well, thank you for contacting E. You have a very good day.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] All right, thank you so much.